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PubMed2004

Intelligence and maturity: meta-analytic evidence for the incremental and discriminant validity of Loevinger's measure of ego development.

This review examined whether Loevinger's measure of personality (ego) development is equivalent to the measurement of intelligence. The authors conducted a meta-analysis of 52 correlations between ego level scores and intelligence test scores (retrieved from 42 studies involving 5,648 participants). The weighted average correlation between ego level and intelligence ranged from.20 to.34, depending on the intellectual ability assessed (e.g., verbal intelligence). Adjusting for measurement unreliability increased these values only minimally. The authors also reviewed 16 studies that examined the association between ego level and various criterion variables (e.g., aggressive behavior) after statistically controlling for the effects of intelligence. Ninety-four percent of the tests revealed significant relations between ego level and criterion variables after controlling for intelligence, indicating that ego development and intelligence are not interchangeable constructs. These findings do not support recent speculations concerning the limited value of stage models of maturity, social development, and moral reasoning.

Adolescent↗
PubMed2002

A critical ethnographic approach to facilitating cultural shift in midwifery.

OBJECTIVE: to improve understanding of local midwifery morale, inform development and reorganisation of a maternity unit, and enhance midwifery involvement in strategic planning. PARTICIPANTS: a randomised stratified sample of 20 midwives working in a UK National Health Service (NHS) hospital and its surrounding community area. METHOD: within a critical ethnographic framework, focus groups were tape-recorded and transcribed, and analysed using a thematic content analysis approach. FINDINGS: key areas affecting midwifery morale were identified, in particular staffing levels, working relationships and organisational issues. One year later, despite many changes having taken place, midwifery morale was still low but participants were more politically analytical of, and actively involved in changing their situation. The findings of the study indicate that there are complex and long-standing cultural inhibitions to the effective development of midwifery care but, if these are made explicit through a planned collaborative process, such as in this study, a process of cultural shift can be seen to begin. IMPLICATIONS FOR PRACTICE: focus groups can be a useful tool in moving midwifery culture forward within a local context.

Anecdotes as Topic↗
PubMedDate not supplied

When you shouldn't do what you want to do: young children's understanding of desires, rules, and emotions.

This research investigated 4- through 7-year-olds' and adults' (n = 64) concepts about the emotional consequences of desire fulfillment versus desire inhibition in situations where people's desires conflict with prohibitive rules. Results revealed developmental increases in attributing positive or mixed emotions to story characters that make willpower decisions and negative or mixed emotions to characters that transgress. These developmental changes in emotion predictions were accompanied by age-related differences in emotion explanations. Whereas 4- and 5-year-olds largely explained emotions in relation to the characters' goals, 7-year-olds and adults further explained how rules and future consequences influence emotions. Results are discussed in relation to connections among children's psychological, deontic, and future-oriented reasoning about emotions as well as the development of self-control.

Adult↗
PubMedDate not supplied

Ethical considerations for a child's participation in research.

ISSUES AND PURPOSE: To analyze ethical considerations for a child's involvement in research. CONCLUSIONS: Pediatric research can proceed only when the welfare of children is protected. Although research with children as research subjects constitutes only a small portion of research efforts, its continual growth requires nurses be aware of the rights of pediatric subjects. PRACTICE IMPLICATIONS: As nursing research increases in sophistication, the nurse should include an assessment of the informed consent process in the care of the patient, including the child's comprehension, the age and development of the child, and the child's perception of the research.

Child↗
PubMedDate not supplied

Beliefs about truth and beliefs about rightness.

Children's developing conceptions of what is right or proper are commonly studied without reference to concomitant changes in their understanding of beliefs, just as studies of young people's maturing grasp of the belief entitlement process ordinarily proceed separately from any examination of the value considerations that invest beliefs with meaning. In an effort to reverse these isolationist practices, a case is made for rereading the fact-value dichotomy that currently works to divide the contemporaneous literatures dealing with children's moral reasoning development and their evolving theories of mind. Findings from two research programs, in which children's beliefs about truth and rightness are combined, serve to illustrate the natural interdependence of these moral and epistemic matters.

Attitude↗
PubMedDate not supplied

Moral responsibility, consciousness and psychiatry.

This article discusses the connection between consciousness and responsibility. Moral responsibility plays a crucial, but often implicit role in psychiatry in that it is often a therapeutic aim as well as an important evaluative concept. This article explains one of the more influential 'psychological' theories of moral responsibility, developed by Harry Frankfurt. In the second part of this article, a modified version of this account is applied to a range of psychiatric phenomena.

Consciousness↗
PubMed1990

[In search of a new morality. Ethical considerations on the Amstad Report].

Against the background of rapid progress in the field of reproduction medicine and gene technology, the governments of various countries have set up commissions to discuss the moral, legal and social problems involved and make proposals for regulation. Thus, in 1986 the Swiss Federal Council convened an expert commission which, after two years of discussion, has recently published a voluminous document (the "Amstad Report"). The present paper attempts to analyze, from the philosophical viewpoint, some of the problems associated with such processes for the further development of morality for specific ends. A leading question in this regard is the role of philosophical thought in these processes, i.e. the potentialities and limits of ethics for the creation of a moral consensus on the problems surrounding technical intervention in human reproduction. There are four schools of thought: 1. The activities of expert commissions are evidence of the fact that man is at present endeavouring consciously to "construct" his morality. He may always have been the subject of his mortality, but this was without his own knowledge and awareness. Today, under the pressure of new means of action, man is becoming the conscious subject of his mortality and the formation of a morality is a process aimed at a specific result. 2. The fundamental difficulty of such a scheme arises from the absence of a theoretical and socially tested system for the "construction" of a new morality. This is also true of philosophy: on questions of morality it possesses analytic competence but no specific methods of generating new norms and values.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethics, Medical↗
PubMed1998

Can professionalism be measured? The development of a scale for use in the medical environment.

PURPOSE: To assess a scale that measures professional attitudes and behaviors associated with the medical education and the residency training environment. METHOD: In 1995-96, the authors surveyed medical students and residents from five institutions in the northeast region of the United States. RESULTS: Of 757 distributed questionnaires, 565 were returned (75% response rate). Of those, 529 (94%) were used in the analysis. The mean score for the retained 12 items was 92.9 (SD, 11.9), with higher scores indicating more positive perceptions. The internal reliability of the scale was moderately high (alpha = .71). A factor analysis identified three subscales: excellence, honor/integrity, and altruism/respect, with eigenvalues (alpha coefficients) of 3.18 (.72), 1.70 (.60), and 1.20 (.59), respectively. CONCLUSIONS: The results are interpreted as an encouraging first step toward the development of a reliable scale that measures professionalism within the environment of medical education and residency training.

Attitude of Health Personnel↗
PubMed2007

[Developmental aspects in expert testimony for juvenile court].

The history of German legislation resulting in the developmental orientation of juvenile court law (JCL) led to setting the minimum age of criminal responsibility at the age of 14, which places Germany within the average range compared to other EU countries, even though most skills regarding the discernment of right- or wrong-doing are developed in earlier stages of life. The requirement put by section sign 3 JCL that legal discernment be emotionally grounded and the necessity to explore context factors (family or group, specific situation) make psychiatric evaluation of adolescents in court a delicate task. It is indispensable that new findings in neurobiology be considered upon making an assessment of the individual neuro-developmental status. In contrast, an assessment according to section sign 105 JCL considers the overall development irrespective of the crime(s). Developmental issues regarding legal prognosis are discussed for some types of offences (homicide, sexual offences, arson).

Adolescent↗
PubMed1998

Universalism in medicine through the ages.

Since man was formed in the divine likeness, God being considered as the source of all truth and goodness, mankind must possess this inherent goodness. It is however, this inherent goodness reflected in the healing activities of mankind which every culture and race has given witness to in all periods of time. This developing in different cultures in different ways throughout the world as a thread of continuity linking the brilliant discoveries of the medical sciences of our own time with that has gone before.

History, 21st Century↗
PubMed1992

Greipp's model of ethical decision making.

Nurses need to become more aware of everyday ethical decisions and the many factors which influence them in order to develop skills in this cognitive process. This author's model of ethical decision making has been designed and developed to illustrate an overall conception of the interaction between nurse and client within an ethical framework. This model lends itself to the examination of all factors which enter into the ethical decision making process: descriptive, normative and meta-ethics.

Beneficence↗
PubMed1999

Proposed model for interaction between residents and residency training programs, and pharmaceutical industry.

Medical residents in training are as much targets of pharmaceutical-industry marketing as are physicians in practice. This interaction is often subtle and takes the form of sponsorship of meals at academic events, support for conference travel, books, and items such as pens and notepads. Most residency programs direct little time towards training in ethics and the critical analysis of pharmaceutical-industry marketing. We propose a model for the relationship between residents and residency programs, and the pharmaceutical industry that addresses the need for such interaction to be viewed in light of the patient-centered ethic of professional conduct and the ideal of unbiased medical practice. A committee of residents at different levels of training and two staff physicians received the mandate to examine this issue. The committee developed a set of guidelines and a proposed schema for the handling of funds from pharmaceutical companies (still not implemented). Each residency program would develop a common fund for money donated by pharmaceutical companies. This fund would be administered by a committee with defined priorities. The presence of residents on this committee under staff preceptorship would serve as a springboard for education on the subject. Guidelines for acknowledgement of sponsorship, solicitation of funds, gifts for care of patients, ongoing education, and the wider applicability of these proposals were also developed. Residents' interaction with the pharmaceutical industry during training could have lifelong influence on medical practice. We hope that our model will promote critical appraisal of the potential risks and benefits of this interaction.

Advertising↗
PubMed1999

Achieving moral health care: the challenge of patient partiality.

Illness and hospitalization are sources of vulnerability; they arguably endow nurses and midwives with the moral obligation to develop caring relationships with patients. Fairness and the equal treatment of patients are central to moral practice; current government publications are giving this political emphasis. This article argues that patient partiality is one factor that may result in insidiously unequal caregiving. Data generated during a qualitative study into professional caring suggest that patient partiality is an accepted part of everyday practice. Factors such as the patient's personality, nurse-patient familiarity and the perceived level of patients' understanding and interest in their illness emerged as possible sources of partiality and influence on practitioners' interactions with patients. The article argues that patient partiality can be managed morally if practitioners develop self-awareness and constantly reflect on the moral integrity of everyday practice. Throughout the article, unless it is stated that specific reference is being made to either nurses or midwives, reference to a nurse or practitioner denotes both. It is also emphasized that no implication is intended that any study participants provided unequal care. Rather, data are utilized solely to generate focused discussion around the concept of patient partiality.

Attitude of Health Personnel↗
PubMed1992

Differences in ethical decision-making processes among nurses and doctors.

The study reports results of an inquiry into the different patterns of ethical decision making used by doctors and nurses. The findings of the study are that nurses and doctors act out of different values, motivations and expectations and that there is a communication gap between them. Nurses place the highest value on the 'caring' perspective, which entails responsiveness and sensitivity to the patients' wishes. In contrast, the doctors value above all the patients' rights and the scientific approach that implies a major concern with disease and its cure. The study suggests that there is a need for the development of a new foundation, based on common professional attributes of the two groups, to which both groups are committed. This would provide a joint point of reference from which the two professions can solve shared ethical problems and would remove communication barriers.

Beneficence↗
PubMed2005

Developing a game plan for good sportsmanship.

It is widely believed in the United States that competition is beneficial for youngsters. However, the media are full of examples of players, fans, and coaches whose behavior veers out of control. There have been well-documented examples of youth in livestock competitions illegally medicating show animals to make them appear calmer, officials biasing their rulings toward a team that will take the most fans to a playoff game, and team rivalries that have become so caustic as to be dangerous for competitors and fans. A university extension and its partners created a program called "Great Fans. Great Sports." in order to teach the kinds of behaviors we wish to instill among all who are involved in competitions. It requires entire communities to develop and implement plans for enhancing sportsmanship in music, debate, drama, 4-H, and other arenas, as well as sports. The goal is to make good sportsmanship not the exception but the norm. The authors provide anecdotal evidence that "Great Fans. Great Sports." is having a positive impact on the attitudes and behaviors of competitors, fans, and communities.

Adolescent↗
PubMed2003

Punishment insensitivity and parenting: temperament and learning as interacting risks for antisocial behavior.

We review ideas about individual differences in sensitivity or responsiveness to common disciplinary behaviors parents use to correct aggressive and antisocial behavior in children. At extremes, children may be seen as "punishment-insensitive," an heuristic with some value relevant to models of the development of antisocial and aggressive behavior disorders. Literature from diverse fields, such as psychopathy, child temperament, socialization and the development of moral conscience, conditioning theory, and personality theory, have all utilized the idea that humans differ in their sensitivity to aversive stimuli and the cues that signal their occurrence, as well as their ability to inhibit reward-driven behavior, in the presence of punishment cues. Contemporary thinking places these dispositions squarely as basic biological aspects of temperament that moderate the effects of the environment (e.g., parenting) on outcomes (e.g., mental health). We review a largely forgotten literature that shows clearly that sensitivity to punishment is also reliably influenced by the environment itself. An attempt is then made to model the interactional processes by which parenting and punishment sensitivities in children magnify or diminish each other's progress toward healthy or antisocial development. Implications for parenting of children with low responsiveness to punishment strategies are discussed.

Antisocial Personality Disorder↗
PubMed2000

Teaching medical students social responsibility: the right thing to do.

As academic medicine has become more focused on the economic pressures of the marketplace, some educators have expressed concern about whether appropriate attention is being given to the character development and moral education of medical students. The authors conclude that medical schools do indeed have a duty to teach their medical students to be socially responsible. They define a socially responsible individual as a person who takes part in activities that contribute to the happiness, health, and prosperity of a community and its members. They suggest that medical students should participate in carefully designed, socially responsible activities in order to (1) practice and have reinforced such qualities as reliability, trustworthiness, dependability, altruism, and compassion; (2) partially reimburse society for the cost of their medical education; (3) increase their exposure to a population-based approach to health care; and (4) help medical schools fulfill their social contract with the public. The authors outline the process for developing a curriculum to teach social responsibility to medical students and list some of the key questions faculty and administrators must address in the processes of development and implementation. They conclude that while faculty responsible for implementing a curriculum in social responsibility must be highly committed and prepared to address numerous difficult questions concerning the curriculum's philosophy, structure, and function, the potential benefits of such a curriculum are well worth the effort.

Curriculum↗
PubMed2004

[The law and the local fairness of care practice. Reflections on the ethnographic field investigation concerning the failure of the Bopz Act in psychogeriatric nursing home care].

Ten years after its introduction the Special Admissions to Psychiatric Hospitals Act (Bopz) still awaits full implementation in the field of psychogeriatric nursing home care. Ethnographic research into moral problems related to care giving in dementia patients in Dutch nursing homes yielded several reasons for this discrepancy between law and care practice. Firstly, practical effectuation of this law rests predominantly on the shoulders of nurses and nurse assistants who are mainly inspired by moral motives such as carefulness and providing safety and who are ill informed about the law and its prerequisites. Secondly, there is the problem of the loss of a common shared world of meaning, which in relational terms is typical for the process of dementia. As a result of this, crucial concepts of the Bopz loose their applicability as the disease progresses. Finally, there is an immanent tension between the anthropology of care and care giving and the anthropological presuppositions of the law, health law included, which on a fundamental level contributes to the resistance of the care practice to the legal procedures of the Bopz. These factors must be accounted for in new legislation or revision of the current law. In the mean time we urge the necessity to develop a moral code concerning how to deal with resistive behaviour and opposition to care of demented nursing home patients.

Aged↗